News

The expected growth in healthcare expenditures from 2017 to 2026 is expected to outpace the growth in gross domestic product (GDP) by 1%, resulting in an increase in the health share of the GDP from 17.9% in 2016 to 19.7% in 2026, according to a CMS report.

By asking difficult questions early in a patient’s care about issues such as housing, food security, and neighborhood crime, case managers can combat common transition-related issues in high-cost or high-need patients. 

When developing or selecting a case management model, what are some components to consider?

We are updating our charges in our RHC and we want to make sure we are capturing all of the preventive services that we can perform in our clinic. Along with that, we want to audit the documentation. Where can we find a list of RHC preventive services?

Q: Our facility has attempted to use the -X{EPSU} modifiers on 2017 and 2018 claims but our Fiscal Intermediary Standard System (FISS) did not process the claims. I reverted to using modifier -59 (distinct procedural service). Do you have any knowledge of when these modifiers might go into use?

Even going out of business doesn’t protect an organization from HIPAA requirements. The Office for Civil Rights recently announced it reached a $100,000 settlement with the receiver liquidating the assets of Filefax, Inc., a Northbrook, Illinois, medical records company that shut down during an investigation of HIPAA violations.

Revenue cycle leaders can fall into a trap of merely managing problems that pop up. But the danger with a “fix it” approach is that so many of the challenges in revenue cycle are connected. 

Q: Are we required to explain why a vulnerability was not addressed or was deemed low priority in the risk management plan? If so, are there any examples of acceptable ways to document this per OCR?

An OIG audit of the University of Michigan Health System revealed noncompliance with four types of inpatient claims, including those associated with billing of DRGs, and two types of outpatient claims, including those billed with modifier –59 (distinct procedural service).

Historically, the social work profession resisted the change from manual documentation to tem­plate-based tools, but with the growing emphasis on quality and reducing hospital readmissions, social workers need to utilize case management assessments as a way to communicate risk and pertinent patient details.